Company Name Full Name : Title: Employee ID#: Dist. #: Dept. Name: Dept.#: Business Street Address: City: State: Select State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska New Hampshire Nevada New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip: Date of Birth: Passport #: Gender: Choose One Male Female Country of Origin: Expiration Date: Office Tel. Number(s): Office Fax Number: E-mail Address: Assistant or Secretary: Assist./Secretary Tel. Number:
Aircraft Seating Preference: Non Smoking: Smoking: Window: Aisle: Other:
Frequent Flyer Programs: Airline 1: Choose One American Delta Continental TWA Southwest Number: Airline 2: Choose One American Delta Continental TWA Southwest Number: Airline 3: Choose One American Delta Continental TWA Southwest Number: Airline 4: Choose One American Delta Continental TWA Southwest Number: Airline 5: Choose One American Delta Continental Southwest Number: Other: Number: Other: Number:
Special Meal Request(s): Airline Club Memberships: Other Travel Preferences: (Car Rental, Hotel, Etc...)
Car Company 1: Number: Choose One Alamo Avis Budget Hertz National Thrifty Car Company 2: Number: Choose One Alamo Avis Budget Hertz National Thrifty Car Company 3: Number: Choose One Alamo Avis Budget Hertz National Thrifty Other Car Company: Number: Other Car Company: Number:
Authorization for Corporate Card Charge: Card Type Select Your Card Mastercard Visa Discover American Express Card # EXP Select Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Select Year 2008 2009 2010 2011 2012 2013 2014 2015 2016
The undersigned traveler and the Company hereby authorize Spears Travel to charge to the credit card account(s) (through signature on file) as indicated on this form, any business travel transactions requested by the undersigned traveler or his authorized agent via telephone or letter while this is in effect. The individual traveler hereby authorizes Spears Travel to charge to his credit card account(s) (through signature on file) as indicated on this form, any personal travel transactions requested by him or his authorized agent via telephone or letter. Signature of Traveler Date
VACATION AND PERSONAL TRAVEL:
City: State: Select State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska New Hampshire Nevada New Jersey New Mexico New York North Carolina North Dakota Ohio Okahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip: Home Telephone: Cell Phone:
Spouse Name: Spouse Date of Birth: Child #1: Child #1 Date of Birth: Child #2: Child #2 Date of Birth: Child #3: Child #3 Date of Birth: Child #4: Child #4 Date of Birth: Child #5: Child #5 Date of Birth:
Other Family/Household Members:
Credit Card Number(s) for Personal Charges: Card #1 Select Your Card Mastercard Visa Discover American Express Card 1 # EXP Select Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Select Year 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Card #2 Select Your Card Mastercard Visa Discover American Express Card 2 # EXP Select Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Select Year 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
The individual traveler hereby authorizes Spears Travel to charge to his credit card account(s) (through signature on file) as indicated on this form, any personal travel transactions requested by him or his authorized agent via telephone or letter. Signature of Traveler Date
